1922052273 NPI number — MRS. LINDA SHAW CRNA

Table of content: MRS. LINDA SHAW CRNA (NPI 1922052273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922052273 NPI number — MRS. LINDA SHAW CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922052273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2529 FALLS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUYAHOGA FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44223-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-543-8823
Provider Business Mailing Address Fax Number:
330-296-6535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PERKINS SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44308-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-543-8823
Provider Business Practice Location Address Fax Number:
330-296-6535
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN237913 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000247231 . This is a "ANTHEM PROVIDER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2358649 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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